The British Journal of Psychiatry
Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys
Daphna Levinson, Matthew D. Lakoma, Maria Petukhova, Michael Schoenbaum, Alan M. Zaslavsky, Matthias Angermeyer, Guilherme Borges, Ronny Bruffaerts, Giovanni de Girolamo, Ron de Graaf, Oye Gureje, Josep Maria Haro, Chiyi Hu, Aimee N. Karam, Norito Kawakami, Sing Lee, Jean-Pierre Lepine, Mark Oakley Browne, Michail Okoliyski, José Posada-Villa, Rajesh Sagar, Maria Carmen Viana, David R. Williams, Ronald C. Kessler



Burden-of-illness data, which are often used in setting healthcare policy-spending priorities, are unavailable for mental disorders in most countries.


To examine one central aspect of illness burden, the association of serious mental illness with earnings, in the World Health Organization (WHO) World Mental Health (WMH) Surveys.


The WMH Surveys were carried out in 10 high-income and 9 low- and middle-income countries. The associations of personal earnings with serious mental illness were estimated.


Respondents with serious mental illness earned on average a third less than median earnings, with no significant between-country differences (χ2(9) = 5.5–8.1, P = 0.52–0.79). These losses are equivalent to 0.3–0.8% of total national earnings. Reduced earnings among those with earnings and the increased probability of not earning are both important components of these associations.


These results add to a growing body of evidence that mental disorders have high societal costs. Decisions about healthcare resource allocation should take these costs into consideration.

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